July 2, 2001 -- Four years ago, at age 44, Seattle resident Caroline Scott Brown underwent a hysterectomy with removal of ovaries.
"Immediately after recovering from the surgery when I found out it was OK for me to start back having sex, I realized that it didn't feel comfortable," Brown says. "I was dry as a bone. It was awful. I was actually irritated just from touching my underwear, and I was avoiding sex.
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Brown was suffering from atrophic vaginitis, a condition in which the vagina becomes dry and overly delicate in response to declining levels of the female hormone estrogen, says Andrew Kaunitz, MD. This decrease in estrogen happens naturally around menopause and temporarily while nursing a baby. But the hormone also drops off quite sharply in women who have surgeries like the one Brown had, especially when their ovaries, the glands that produce estrogen, are removed.
The changes women will notice are quite visible, says Gloria Bachmann, MD, associate dean for women's health at the Robert Wood Johnson Medical School in New Brunswick, N.J.
"One of the first signs one sees on pelvic examination is that the vaginal area is very dry, it's very pale, and it loses the wrinkling that most younger women have," she says. "As it progresses, the vaginal area gets thinner and smoother, and it easily bleeds. ... The degree of it is sometimes variable. A 50-year-old who comes in today to see me may have horrible symptoms, whereas another 50-year-old may not be at that point and may still have some lubrication."
All these changes can make atrophic vaginitis, "a very important but frequently not discussed caused of female sexual dysfunction," says Kaunitz, professor and assistant chairman of the department of obstetrics and gynecology at the University of Florida Health Science Center in Jacksonville and director of menopausal services for the University of Florida Medical Women's Center.